SB 6 — Parity for Non-Opioid Pain Management Drugs

SecondNOTE: Regular Session Seventy-fifth General Assembly STATE OF COLORADO REREVISED This Version Includes All Amendments Adopted in the Second House LLS NO.

26-0027.01This Shelbybill Rosshas x4510been SENATEprepared BILLfor 26-006the SENATEsignatures SPONSORSHIPof Amabilethe andappropriate Kirkmeyer,legislative Bright,officers Catlin, Coleman, Cutter, Frizell, Pelton B., Wallace HOUSE SPONSORSHIP Brown and Taggart,the Bacon,Governor. Boesenecker, Duran, McCormick, Sirota, Smith n d e 2 S R 2 U 3 6 H d y d M Senate Committees House Committees e Health & Human Services Health & Human Services m Appropriations Appropriations A i A BILL FOR AN ACT a 2 S e 2 C ONCERNINGPARITYFORTHEUSEOFNON -OPIOIDPAINMANAGEMENT U d ,5 H 2 a DRUGS , AND , IN CONNECTION THEREWITH , MAKING AN d M d APPROPRIATION .

eTo mdetermine Awhether Billthe SummaryGovernor dhas (Note:signed the bill or taken other action on it, please consult the legislative status sheet, the legislative history, or the Session Laws.

ThisSENATE summaryBILL applies26-006 toBY thisSENATOR(S) billAmabile as introduced and doesKirkmeyer, dBright, eCatlin, 6Cutter, notreflectanyamendmentsthatmaybesubsequentlyadopted.IfthisbillFrizell, EPelton aB., 0Wallace, passesColeman; third reading in the house of introduction, a bill summary that T U , N g 2 applies to the reengrossed version of this bill will be available at S d r http://leg.colorado.gov.) e A d The bill requires a health insurance carrier that provides prescription drug benefits to require that:

!also TheREPRESENTATIVE(S) utilizationBrown review requirements, including prior g authorization and stepTaggart, therapy,Bacon, forBoesenecker, aDuran, non-opioidMcCormick, drugSirota, dSmith. e 2 prescribed and approved by the federal food and drug E R 0 A n , N 2 1 Shading denotes HOUSE amendment.

DoubleCONCERNING underliningPARITY denotesFOR SENATETHE amendment.USE OF NON -OPIOID PAIN MANAGEMENT DRUGS , AND , IN CONNECTION THEREWITH , MAKING AN APPROPRIATION .

S e r Capital letters or bold & italic numbers indicate new material to be added to existing law.n Ap Dashes through the words or numbers indicate deletions from existing law.

m A administration (FDA) for the treatment or management of chronic or acute pain (non-opioid pain management drug) are no more restrictive than the least restrictive utilization review requirements for opioid drugs prescribed for the treatment or management of chronic or acute pain;

! There is at least one clinically appropriate non-opioid prescriptiondrugavailableasanalternativeforeachopioid prescription drug;

and ! The cost-sharing, copayment, or deductible for a non-opioid pain management drug is not greater than the cost-sharing, copayment, or deductible for an opioid drug prescribed for the treatment or management of chronic or acute pain.

The bill requires the department of health care policy and financing to ensure that the utilization review requirements, including prior authorization or step therapy, for a non-opioid prescription drug prescribedandapprovedbytheFDAforthe treatmentormanagementof chronic or acute pain are no more restrictive than the least restrictive utilization requirements for opioid drugs prescribed for the treatment or management of chronic or acute pain.

SECTIONSECTION1. 1.

InInColoradoRevisedStatutes,10-16-145.5,add(2.5) Colorado Revised Statutes, 10-16-145.5, add (2.5) as follows:

Step therapy - prior authorization - prohibited - stagefouradvancedmetastaticcancer-non-opioidpainmanagementstage four advanced metastatic cancer - non-opioid pain management drug - definitions.

(2.5)(a)(2.5) OTWITHSTANDINGSECTION(a) 10-16-145ACARRIERTHATNOTWITHSTANDING SECTION 10-16-145, A CARRIER THAT PROVIDES PRESCRIPTION DRUG BENEFITS SHALL REQUIRE THAT :

(I)T(I) T HE UTILIZATION REVIEW REQUIREMENTS ,INCLUDING PRIOR AUTHORIZATIONANDSTEPTHERAPY ,FORANON -OPIOIDDRUGPRESCRIBED AND APPROVED BY THE FDA FOR THE TREATMENT OR MANAGEMENT OF CHRONIC OR ACUTE PAIN ARE NO MORE RESTRICTIVE THAN THE LEAST RESTRICTIVE UTILIZATION REVIEW REQUIREMENTS FOR OPIOID DRUGS PRESCRIBED FOR THE TREATMENT OR MANAGEMENT OF CHRONIC OR -2- 006 ACUTE PAIN ;AND 3 (II) THE COST -SHARING, COPAYMENT , ORINCLUDING DEDUCTIBLEPRIOR FOR________ ACapital NONletters -OPIOIDDRUGPRESCRIBEDFORTHETREATMENTORMANAGEMENTOFor CHRONICbold OR& ACUTEitalic PAINnumbers ISindicate NOnew GREATERmaterial THANadded THEto COSTexisting -SHARINGlaw; , COPAYMENT ,OR DEDUCTIBLE FOR AN OPIOID DRUG PRESCRIBED FOR THE TREATMENT OR MANAGEMENT OF CHRONIC OR ACUTE PAIN .

(b)dashes (I)through XCEPTwords ASor PROVIDEDnumbers INindicate SUBSECTIONdeletions (2.5)(b)(IOFfrom THISexisting SECTIONlaw ,ALLand INDIVIDUALsuch ANDmaterial SMALLis GROUPnot HEALTHpart BENEFITof PLANSthe ISSUEDORRENEWEDINTHISSTATEONORAFTERact. JANUARY 1,2027,SHALL ENSURE THERE IS AT LEAST ONE NON -OPIOID PRESCRIPTION DRUG AVAILABLE AS A CLINICALLY APPROPRIATE ALTERNATIVE FOR AN OPIOID PRESCRIPTION DRUG .

(II)AUTHORIZATION UBSECTIONAND (2.5)(b)(IOFTHISSECTIONISINOPERATIVESTEP THERAPY ,FOR A NON-OPIOID DRUG PRESCRIBED AND APPROVED BY THE STATEFDA SHALLFOR NOTTHE ASSUMETREATMENT ANOR OBLIGATIONMANAGEMENT FOROF CHRONIC OR ACUTE PAIN ARE NO MORE RESTRICTIVE THAN THE COVERAGELEAST REQUIREDRESTRICTIVE PURSUANTUTILIZATION TOREVIEW SUBSECTIONREQUIREMENTS (2.5)(b)(OFFOR THISOPIOID SECTIONDRUGS IFPRESCRIBED FOR THE DIVISIONTREATMENT DETERMINESOR THATMANAGEMENT OFCHRONIC OR ACUTE PAIN;AND (II) THE BENEFITCOST SPECIFIED-SHARING IN,COPAYMENT SUBSECTION, (2.5)(b)(IOFOR THISDEDUCTIBLE SECTIONFOR REQUIRESA STATENON DEFRAYAL-OPIOID DRUG PRESCRIBED FOR THE TREATMENT OR MANAGEMENT OF CHRONIC OR ACUTE PAIN IS NO GREATER THAN THE COST OF-SHARING COVERAGE, PURSUANTCOPAYMENT TO,OR ADEDUCTIBLE PROVISIONFOR OFAN OPIOID DRUG PRESCRIBED FOR THE FEDERALTREATMENT ACTOR ,INCLUDINGMANAGEMENT 42OF U.S.C.CHRONIC OR ACUTE PAIN .

(b) (I) EXCEPT AS PROVIDED IN SUBSECTION (2.5)(b)(IIOF THIS SECTION,ALLINDIVIDUALANDSMALLGROUPHEALTHBENEFITPLANSISSUED OR RENEWED IN THIS STATE ON OR AFTERJANUARY 1,2027, SHALL ENSURE THERE IS AT LEAST ONE NON-OPIOID PRESCRIPTION DRUG AVAILABLE AS A CLINICALLYAPPROPRIATEALTERNATIVEFORANOPIOIDPRESCRIPTIONDRUG .

(II) SUBSECTION (2.5)(b)(IOF THIS SECTION IS INOPERATIVE AND THE STATE SHALL NOT ASSUME AN OBLIGATION FOR THE COVERAGE REQUIRED PURSUANT TO SUBSECTION (2.5)(b)(IOF THIS SECTION IF THE DIVISION DETERMINES THAT THE BENEFIT SPECIFIED IN SUBSECTION (2.5)(b)(IOF THIS SECTION REQUIRES STATE DEFRAYAL OF THE COST OF COVERAGE PURSUANT TO A PROVISION OFTHE FEDERALACT ,INCLUDING 42 U.S.C.

18031 (d)(3)(BOR(d)(3)(B) OR A SUCCESSOR PROVISION,ANDPROVISION , AND THE IMPLEMENTING REGULATIONS OR THE STATE IS OTHERWISE REQUIRED TO DEFRAY THE COST OF COVERAGE REQUIRED PURSUANT TO SUBSECTION (2.5)(b)(IOF THIS SECTIO.

(III) ALL LARGE EMPLOYER HEALTH BENEFIT PLANS ISSUED OR RENEWED IN THISSTATETHIS STATE ON AND AFTER JANUARY 1,2028,1, SHALLENSURE2028SHALL THEREISATLEASTONEENSURE NONTHERE -OPIOIDPRESCRIPTIONDRUGAVAILABLEASAIS CLINICALLYAT APPROPRIATELEAST ALTERNATIVEONE FORNON-OPIOID ANPRESCRIPTION OPIOIDDRUG PRESCRIPTIONAVAILABLE -3-AS 006A DRUGCLINICALLYAPPROPRIATEALTERNATIVEFORANOPIOIDPRESCRIPTIONDRUG .

(IV) THECOVERAGEREQUIREDBYTHISSUBSECTIONT (2.5MAYBEHE COVERAGE REQUIRED BY THIS SUBSECTION (2.5)MAY BE OFFERED THROUGH A HIGH DEDUCTIBLE PLAN THAT WOULD QUALIFY FOR A HEALTHHEALTHSAVINGSACCOUNTPURSUANTTO SAVINGS26U.S.C.SEC ACCOUNT.223;EXCEPTTHAT PURSUANTACARRIERMAYAPPLYDEDUCTIBLEAMOUNTSFORTHEREQUIREDCOVERAGE IF IT IS NOT CONSIDERED BY THE U NITED STATES DEPARTMENT OF THE PAGE 2-SENATE BILL 26-006 TREASURY TO 26BE U.S.C.SEC.PREVENTIVE OR TO HAVE AN ACCEPTABLE DEDUCTIBLE .

223EXCEPT(c) THATT AHIS CARRIERSUBSECTION MAY(2.5)DOES NOT APPLY DEDUCTIBLETO AMOUNTSA FORGROUP THEBENEFIT REQUIREDPLANISSUEDPURSUANTTOTHE COVERAGEIFITISNOTCONSIDEREDBYTHE"STATE UE NITEDSTATESDEPARTMENTMPLOYEE OFG THEROUP TREASURYB TOENEFITSA BECT", PREVENTIVEPART OR6 TOOF HAVEARTICLE50 ANOF ACCEPTABLETITLE24. DEDUCTIBLE .

(c) THIS SUBSECTIO(2.5)DOES NOT APPLY TO A GROUP BENEFIT PLAN ISSUED PURSUANT TO THE "STATE E MPLOYEE G ROUP BENEFITS A CT",PART6 OF ARTICLE50OF TITLE24.

For the 2026-27 state fiscal year, $15,415$15,415isappropriatedtothedepartmentof isregulatoryagenciesforuseby appropriated to the department of regulatoryagencies for use by the division of insurance.

This appropriation is from the division of insurance cash fund created in section 10-1-103 (3)(a)(I), C.R.S., and is basedbasedonanassumptionthatthedivisionwillrequireanadditional0.2FTE. on an assumption that the division will require an additional 0.2 FTE.

To implement this act, the division maymayuse use this appropriation for personal services.

on the day following the expiration of the ninety-dayperiodafterfinaladjournmentofthegeneralassembly(Augustninety-dayperiod after final adjournment of the general assembly(August 12, 2026, if adjournment sine die is on May 13, 2026);

except that, if a referendumreferendumpetitionisfiledpursuanttosection1(3)ofarticleVofthestate petition is filed pursuant to section 1 (3) of article V of the state constitution against this act or an item, section, or part of this act within such period, then the act, item, section, or part will not take effect unless approvedapprovedbythepeopleatthegeneralelectiontobeheldinNovember2026 byPAGE the3-SENATE peopleBILL at26-006 the general election to be held in -4- 006 November 2026 and, in such case, will take effect on the date of the official declaration of the vote thereon by the governor.

-5-____________________________ 006____________________________ James Rashad Coleman, Sr.

Julie McCluskie PRESIDENT OF SPEAKER OF THE HOUSE THE SENATE OF REPRESENTATIVES ____________________________ ____________________________ Esther van Mourik Vanessa Reilly SECRETARY OF CHIEF CLERK OF THE HOUSE THE SENATE OF REPRESENTATIVES APPROVED________________________________________ (Date and Time) _________________________________________ Jared S.

Polis GOVERNOR OF THE STATE OF COLORADO PAGE 4-SENATE BILL 26-006